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NSAID use and unnatural deaths after cancer diagnosis: a nationwide cohort study in Sweden

  • Shen, Qing1
  • Sjölander, Arvid1
  • Sloan, Erica K.2
  • Walker, Adam K.2, 3, 4
  • Fall, Katja5, 6
  • Valdimarsdottir, Unnur1, 7, 8
  • Sparén, Pär1
  • Smedby, Karin E.1, 9
  • Fang, Fang5
  • 1 Karolinska Institutet, Stockholm, SE-171 77, Sweden , Stockholm (Sweden)
  • 2 Monash University, Parkville, VIC, 5052, Australia , Parkville (Australia)
  • 3 Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, New South Wales, 2031, Australia , Randwick (Australia)
  • 4 University of New South Wales, Sydney, 2052, Australia , Sydney (Australia)
  • 5 Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SE-171 77, Sweden , Stockholm (Sweden)
  • 6 Örebro University, Örebro, SE-701 82, Sweden , Örebro (Sweden)
  • 7 University of Iceland, Reykjavik, IS-101, Iceland , Reykjavik (Iceland)
  • 8 Harvard T. H. Chan. School of Public Health, Boston, MA, 02115, USA , Boston (United States)
  • 9 Karolinska University Hospital, Stockholm, SE-171 77, Sweden , Stockholm (Sweden)
Published Article
BMC Cancer
Springer (Biomed Central Ltd.)
Publication Date
Jan 17, 2022
DOI: 10.1186/s12885-021-09120-9
Springer Nature
  • Research


BackgroundCancer patients experience increased risk of death from accident and suicide. Cognitive impairment induced by cancer-related inflammation and stress-related psychiatric symptoms may be underlying mechanisms. We therefore studied the association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of these outcomes.MethodsFollowing a cohort of 388,443 cancer patients diagnosed between October 2005 and December 2014 in Sweden, we ascertained dispense of aspirin or non-aspirin NSAIDs from 3 months before cancer diagnosis onward and defined the on-medication period as from date of drug dispense until the prescribed dosage was consumed. Follow-up time outside medicated periods and time from unexposed patients were defined as off-medication periods. We used Cox models to estimate hazard ratios (HRs) of death due to suicide or accident, by comparing the on-medication periods with off-medication periods.ResultsIn total, 29.7% of the cancer patients had low-dose aspirin dispensed and 29.1% had non-aspirin NSAIDs dispensed. Patients with aspirin use were more likely to be male than patients without aspirin use. Compared with off-medication periods, there was a 22% lower risk of accidental death (N = 651; HR 0.78, 95% confidence interval [CI]: 0.70 to 0.87) during on-medication periods with aspirin. The use of aspirin was not associated with risk of suicide (N = 59; HR 0.96, 95% CI: 0.66 to 1.39). No association was noted between use of non-aspirin NSAIDs and the risk of suicide (N = 13; HR 0.95, 95% CI: 0.42 to 2.18) or accidental death (N = 59; HR 0.92, 95% CI: 0.68 to 1.26).ConclusionsIntake of low-dose aspirin after cancer diagnosis was associated with a lower risk of unnatural deaths among cancer patients.

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